Healthcare Provider Details

I. General information

NPI: 1477684009
Provider Name (Legal Business Name): IVY ALWELL MSN,APRN,BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 HICKORY RIDGE RD STE 600
HILLSBORO MO
63050-5117
US

IV. Provider business mailing address

18104 SUNNY TOP CT
WILDWOOD MO
63038-1445
US

V. Phone/Fax

Practice location:
  • Phone: 636-481-6040
  • Fax:
Mailing address:
  • Phone: 636-405-0933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number145271
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: